PURPOSE: To report a collateral pathway involving the deep circumflex iliac artery causing a type II endoleak following endoluminal exclusion of an abdominal aortic aneurysm (AAA).
CASE REPORT: A 75-year-old man was investigated for a persistent type II endoleak 2 years after endovascular AAA repair with a Zenith Trifab stent-graft. Angiography revealed contrast in the sac from a lumbar artery fed via a collateral of the deep circumflex iliac artery. The lumbar artery was embolized with coils, but an endoleak persisted and is being followed.
CONCLUSIONS: This collateral pathway is easily missed during angiography for endoleaks and should be considered where an endoleak is suspected but cannot be found.